| NPI | 1265942676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MAROON Managing Member/Owner 860-894-2933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: CT CT006968) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2019-07-18 |